Why Does Flipped Learning Work In Healthcare Education?

Panopto has been working with social enterpriseKids’ Health Matters CIC over the past two years to help them expand their use of video for learning. We caught up with Katie Barnes, an Advanced Paediatric Nurse Practitioner (APNP) at the Emergency Department of Alder Hey Children’s Hospital in the UK – and the Founder of Kids’ Health Matters – to find out why they started using video, how it has helped and what her advice would be to other healthcare professionals who want to boost education and training opportunities using video.

Could you give an introduction to Kids’ Health Matters and what some of your learning challenges were?

Kids’ Health Matters (KHM) is a non-profit, social enterprise (otherwise known as a community interest company) that has created an online learning platform called Advance. The Advance platform is aimed at professionals working in nursing, allied health and medicine who want to enhance their knowledge and skills in paediatric and neonatal care.

Advance was created as part of Kids’ Health Matters because I was becoming increasingly aware of an education and training gap that I thought could be filled with some kind of technology-enhanced learning provision. At one end of the learning continuum, many universities offered Advanced Clinical Practice (ACP) Programmes for health professionals, but these frequently had little paediatric or neonatal content. At the other end of the spectrum, there were the paediatric and neonatal National Health Service (NHS) clinicians with phenomenal clinical expertise, but limited opportunities to disseminate their knowledge on a wider scale. I wanted to bridge this gap and so I came up with the idea of creating a shared online educational resource for advanced paediatric and neonatal practice that connected University expertise with NHS expertise – without the challenges imposed by geography or organisational boundaries. I also wanted to create an educational model that was agile, responsive, clinically relevant and designed for busy lives and packed diaries.

To do this, we decided to develop a range of online modules and resources that could be embedded into existing MSc Advanced Practice programmes (for nurses or allied health professionals) and postgraduate educational programmes (for trainee doctors). Our collaborative work withLiverpool John Moores University and the North West School of Paediatrics created a more robust paediatric and neonatal workforce and really solidifies the vital link between University programmes and the NHS. The topics we developed spanned foundational areas such as paediatric physical assessment, history-taking, and pathophysiology right through to more specialised assessment and management of a wide variety of acute and chronic conditions affecting infants, children and young people across a range of healthcare settings. My idea was to remove barriers created by geography or organisations so that we could:

Gain economies of scale in paediatric and neonatal workforce development

Improve the clinical relevance and quality of our advanced education and training

Create better inter-professional collaboration across organisations

The ultimate goal of all of this, of course, was to improve the care for infants, children and young people.

Tell us how you got started with video learning.

Well, given that a key part of our story at Kids’ Health Matters, Advance centres aroundflipping the classroom for our learners, I want to flip that question, to first give you a sense of where we ended up. By flipping the question, I can highlight some of the key reasons we chose to use video to enhance our learning offering – namely, the ability to offer on-demand learning resources at scale and irrespective of the location of the learner.

So, the punch line first: with Panopto driving our Advance programme, we have successfully trained 49 Advanced Practitioners in the first two cohorts with another 35 or so starting in September; this means a significant boost for the NHS on the ground. These learners are spread across ambulatory paediatrics, acute paediatrics and neonatal critical care across the UK – from Northern Ireland to Birmingham (with Cheshire and Merseyside leading the way). Would we have managed to serve such a broad and diverse range of learners without exploiting the advantages of video and online learning? I think that if we hadn’t used video, our goals would have been severely compromised. By taking that initial leap and starting to use a video platform, we have really been able to push the boundaries of what is possible with learning for advanced healthcare education and practice.

As flipped learning has been so central to the Advance programme at KHM, how would you define a flipped classroom?

For anyone unfamiliar with the term, a flipped classroom (or inverted learning model) is a different way of thinking about how (and when) learners direct their own learning, as well as how (and when) tutors help to facilitate and extend learning.

In our interpretation of the flipped classroom model, core course content is shared via video prior to the tutor-facilitated session. This means it can be absorbed by learners at their own pace. Then, what would have been traditional lecture-type delivery becomes a live session andwebcast, attended either face-to-face or via a web link. This session can focus on applications of the pre-session content and foster deeper connections. It can also be used for group work or facilitated discussions. Our goal is for our learners to gain a more in-depth understanding of any given topic by exploiting the social power of learning.

Having flipped my answer to the previous question somewhat, I want to go back to respond to the question of why we became so interested in flipping the classroom. First, we began by thinking at a macro level about how we could design an effective learning process.

According to Bloom’s (Revised) Taxonomy of Cognitive Processes, learners move through various stages during the learning process:

Remembering and Understanding

Applying

Analysing

Evaluating

Creating

Given that the learner has these different cognitive processes going on, the question then becomes: how do you best support each element of the learning journey? For us, the ‘Remembering and Understanding’ phase seemed best supported with a more traditional lecture format but with modifications that could also encourage more self-directed learning. The ‘Applying’, ‘Analysing’, ‘Evaluating’ and ‘Creating’ phases were where we wanted the educational ‘zing’ of facilitated case-based discussions, led by senior clinicians. This would enable all that ‘Remembering and Understanding’ to be put into a practical context of clinical decision-making in paediatrics and neonatology.

As we became more knowledgeable about various learning methodologies, we felt that the flipped classroom model created a more exciting, relevant way of approaching the type of clinical content and application we needed for our developing workforce in advanced paediatrics and neonatology.

We have now flipped all of our ‘classrooms’ in all of our paediatric clinical modules. We also made all our so-called ‘upside down’ teaching accessible to our trainees across all three pathways – ambulatory paediatrics, acute paediatrics and neonatal critical care. Both our on-demand flipped sessions and our live, case-based sessions were powered by Panopto and it was so useful to have just one platform that could do everything we wanted. In truth, none of this would have been possible without our ability to record, webcast, and post the educational content created using Panopto.

Tell us about your ‘scheduled’ and ‘flexible’ video content.

To make the flipped idea easier for our learners to understand, we called the flipped video sessions ‘flexible content’ (because it was available online 24/7) and the live webcasts of case-based discussions the ‘scheduled content’ (because it had specific start and finish times.) We didn’t want the learners to be focused on the learning methodology we’d chosen, but on the content and the learning process. We felt that the terms ‘flexible’ and ‘scheduled’ really encapsulated the way we wanted them to think about our complementary delivery methods.

The flexible content was usually a recording of me (or another of our clinical experts) guiding our trainees through the foundations of a given topic with integrated video, audio and a PowerPoint slide deck. While I know some people are worried about appearing on camera, my advice to them would be – just go for it. If staff are really unhappy with the idea of appearing on camera, the option is always there to record without the video component. However, I’m a big advocate of using video as part of the recordings as I really believe that having a talking head of a tutor or instructor alongside slides or screen capture enhances the overall engagement for learners. Having worked in paediatrics for decades and knowing that from our earliest moments as babies we are programmed to respond to human faces above all else, it makes perfect sense to me that having a video of a tutor talking alongside other learning materials helps improve learner engagement. This has been noted in somestudies with students in higher education too.

For the scheduled (webcast) content, we set up a camera to capture the live discussion with our clinical experts, our KHM faculty and trainees that are able to attend face-to-face. Distance learners log into the live broadcast and ask questions of their own, using Panopto’s live discussion feature. This really helps to bring the cohort together and gives all trainees an opportunity to participate and engage. It was crucially important that our distance learners felt as engaged as our face-to-face learners during the scheduled sessions.

What did your learners think of your flipped learning approach for healthcare?

We recently had an independent organisation evaluate the work we did on implementing this flipped approach and they found that our learners had generally extremely positive perspectives on this new mode of learning, as well as on our blended learning provision. In the report, the evaluator commented that:

“Trainees were very positive about the flipped classroom, and the experience of blended learning. For trainees in employment with busy family lives, the accessibility of the specialist modules promotes learning, as it is a convenient way to study. Moreover, it affords trainees the opportunity to understand how they learn better, by understanding their ‘saturation’ point, as well as developing self-organising and time management skills.”

This has encouraged us to carry on with this way of structuring our modules and learning resources so that we continue to provide clinically relevant, accessible and flexible advanced practice education.

Do you have any words of advice for anyone in healthcare new to video for learning?

I think the results we’ve seen so far speak for themselves – video can help you provide compelling, engaging learning materials that students can access at the point of need, even if they have professional or family commitments. I think this can only drive up the quality of education in advanced healthcare practice. So what would I say to my fellow healthcare professionals? I have three thoughts to help you get started:

Be brave. It can be daunting to try something new, but the benefits are often huge. Remember, you can always course-correct along the way, even if things aren’t 100% right the first time around.

Seek feedback from your learners. When you implement a blended or flipped learning approach, it’s important to sense-check the views of your learners along the way. For instance, we realised that we needed to release flipped material potentially a little earlier than we originally planned so that our trainees felt confident they had enough time to absorb and direct their uptake of the flexible content. By staying in touch with the needs of your learners you can make sure you provide them with the best possible learning experience.

Just try flipped learning. We have seen such a great impact on our delivery – I really think it could be a great way for many healthcare professionals to share expertise more effectively.